Horizon Health Network determined it should develop a “short-stay” ward of the Saint John Regional Hospital for people experiencing acute mental health crises, but the recommendations of an internal review have yet to be implemented.

The internal review came after the death of Hillary Hooper, 27, who died by suicide on Dec. 9, 2020, following a weeks-long hospitalization in the regional hospital’s 4D North ward.

Now, an inquest is tasked with determining the circumstances of Hooper’s death at the hospital, with the five-person jury to make recommendations to avoid deaths under similar situations.

The jury has heard testimony from over a dozen people, including Horizon Health leadership, mental health professionals, and law enforcement officers, providing insight into the woman’s final days.

Renée Fournier, director of addictions and mental health services for Horizon Health’s greater Saint John region, testified the health network held internal process reviews following Hooper’s death, and ultimately recommended a “crisis stabilization unit” for short-term mental-health related stays separate from the hospital’s psychiatric wing.

The intention, she said, is to “stabilize them quickly,” and provide coping skills for people to go back to their normal lives, adding Fredericton’s Dr. Everett Chalmers Hospital has a “well-established” unit.

The short-stay unit has yet to be developed in Saint John’s hospital, though. Fournier said COVID-19 pandemic has made progress "challenging."

The other recommendation, which was to remove the top of doors in order to prevent suicide by hanging, had been implemented, she added.

Hooper had been staying in the Saint John Regional Hospital for nearly three weeks when she made her final suicide attempt on Dec. 2, 2020.

Hooper had been in the psychiatric ward since a suicide attempt on Nov. 13, 2020, when she overdosed on prescription medication. Lauren Oulton, a mental health nurse who assessed Hooper in the emergency room that day, described the 27-year-old as “unshakeable” in her resolve to end her life.

Hooper had been diagnosed with borderline personality disorder, which included attention-seeking behaviour, self-harm and other maladaptive coping strategies, as well as vast fluctuation in emotions and intense moods, among others.

Dr. Alan Fostey, a psychiatrist who worked with Hooper, also said a short-stay ward would be helpful, as people with borderline personality disorder can sometimes be hospitalized “longer than they need to” because they become “dependent” on the artificial environment of a psychiatric ward.

A short-stay unit, staffed by therapists who specialize in dialectical behaviour therapy, means people with borderline personality disorder can “learn the skills they need” and return to the community, he said.

He and Hooper had been discussing her upcoming discharge before her suicide, he said, though no date had officially been set for her to leave hospital.

Fostey said Hooper had expressed reservations about returning home because she was “really comfortable,” in 4D North. She’d been there for longer than normal as they were tweaking her medication, which is a lengthy process, he said.

Hooper’s final moments

Nurses on 4D North were repeatedly questioned on their practices related to “charting” patients, as well as the frequency by which the patients are checked. Patients who are highest-risk receive one-on-one observation, then receive “close” checks every 15 minutes. Those ready to be discharged, like Hooper, receive checks on the hour, psychiatric nurse Karen Wood said.

Wood was the charge nurse on 4D North the night of Hooper’s final suicide attempt.

During the 11 p.m. hourly round of bed checks, Wood found Hooper’s door had been barricaded by a hospital bed. She continued her round of the ward and then returned to Hooper’s room, eventually pushing open the door and finding the room was empty.

The pair noticed the light was on in the bathroom and the door was jammed. When the nurses opened the door after “four or five” tries, they found Hooper, who had attempted suicide.

Hooper “groaned,” she said, and had a pulse. They performed CPR until the hospital’s “code blue” team arrived to continue the resuscitation efforts. Hooper was then moved to the hospital’s intensive care unit.

Michael Johnston, a regional coroner for the province, said tests performed in the ICU showed Hooper was having continuous seizures, which weren’t visible due to her sedation.

“Prognosis was very poor,” he said.

Hooper's 'devastating' death

Medical professionals testified they were surprised to hear the news of Hooper’s suicide, describing the young woman as bright, friendly, and a lover of dirty jokes.

“She was a wonderful patient,” Fostey, said, describing her suicide as “devastating.”

“It’s still upsetting for me,” he said. “I really liked her.”

Since Hooper’s death, her mother, Patricia Borthwick, has been searching for answers as to how her daughter, who had a history of mental illness and suicide attempts, managed to die by suicide while on a closely monitored psychiatric ward.

After hearing two days worth of testimony, Borthwick said some of the information has conflicted with what she’d previously been told by Horizon top brass over three meeting since her daughter's death.

“They told us one story,” she said. “That was the only information we’d ever been given.”

Borthwick said she believed the testimony of “boots-on-the-ground” workers who had dealt with her daughter directly.

Testimony is to continue on Wednesday.

For those experiencing a mental health crisis, the Saint John Mobile crisis line is 1-888-811-3664 and the Chimo Help-Line is 506-450-4357. The Kids Help Phone is 1-800-668-6868.

Marlo Glass, Local Journalism Initiative Reporter, Telegraph-Journal